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A major challenge that is not sufficiently
Rapport public thématique
Executive summary
February 2022
Renowned infectiology research but insufficient priority given to
emerging and re-emerging infectious diseases
French research in infectiology, all the medical disciplines devoted to the study of
infectious diseases, is at a very honourable level in international rankings, judging by the
bibliometric analysis of work in this discipline. Thus, over the 2014-2018 period, France ranked
in terms of the number of its publications in this field, a performance that is all the more
marked given that our country only ranks 8
for life sciences research as a whole.
However, the Covid-19 pandemic crisis has highlighted the lack of preparation,
anticipation and priority given by France to the fight against emerging infectious diseases. Our
country had nevertheless demonstrated, with regard to the fight against AIDS, from 1988, its
ability to structure a community of researchers and to maintain a high level of funding for
studies and trials concerning HIV. The creation of the ANRS (National Agency for Research
on AIDS and Viral Hepatitis), a coordination and resource agency dedicated to research
against HIV/AIDS, against viral hepatitis shortly after 2020, against tuberculosis and sexually
transmitted infections (STIs), appears to have been one of the conditions for this success.
France has not been able to build the same mobilization around the fight against emerging
infectious diseases. In fact, it was not able to quickly produce a vaccine or drug prophylaxis
against Covid-19.
Over the past twenty years, several epidemic episodes have been early warning signals
(Zika, Ebola, H1N1, SARS-CoV-1, etc.). However, these events have not led to any structuring
movement or definition of a particular strategy on the part of the public authorities with regard
to emerging diseases, in particular linked to the coronavirus. Substantial sums have certainly
been granted via the future investment programmes (PIA) to certain organisations. But these
various measures were taken in the absence of an overall vision and without concern for the
future. As a result, essential equipment for this research, such as cryo-electron microscopes,
was lacking in number at the time of the Covid-19 crisis.
Funds devoted to research in infectiology outside universities from 2015 to 2020
(budgetary allocations, PIA and own resources)
Source: Court of Accounts based on financial data collected from the following organisations: IP Paris and Lille, Inserm, CNRS,
The overall funding granted to research in infectiology is not, moreover, subject to any
specific monitoring by the ministries responsible for research and health. Although we observe
a slight increase in this area, of around 14% between 2015 and 2020 (unlike the funding
granted to research in the life sciences, which decreased by around 12% over the period),
these resources have not been given a clear priority. By comparison, the average annual
amount of funding by calls for projects granted by the ANRS for research into AIDS and
hepatitis over the period 2014-
2020 (€41.4 million) was almo
st three times higher than the total
funding granted by the National Research Agency (ANR) to other infectious diseases (€16.2
Comparison of the amounts of funding granted by the ANRS and the ANR to research
projects in infectiology in €M from 20
14 to 2020
Source: Court of Accounts, according to ANR and ANRS data
Weaknesses in terms of management and attractiveness of the
research profession
Stakeholders in infectious disease research
Source: Court of Accounts
Like the rest of biomedical research, research in infectiology suffers from insufficient
management by the many stakeholders involved, whether ministries or the national alliance
for life and health sciences (AVIESAN), which is responsible for coordinating research
operators and establishing a common roadmap. Apart from the unifying role played by the
ANRS in the area of HIV and AIDS, the initiatives are not coordinated and the number of joint
projects remains limited. This observation also applies to the support network for research
abroad, the existence of which is particularly important in terms of infectiology and where
France has, thanks to significant research forces, a first-class comparative advantage.
Organisations with projects funded by the ERC
Research organisations with more than
four projects
Number of
(in €)
Pasteur Institute
Weizmann Institute
Tel Aviv University
University of Cambridge
University of Glasgow
Helmholtz Center for Infection Research
Hebrew University of Jerusalem
University of Copenhagen
ETH Zurich
University of Edinburgh
Max Planck Society
Source: Permanent representation of France to the European Union
The plurality of research organisations, each of which has its own information systems
and management rules, makes the management of research units more complex, most of
which are placed under the supervision of several institutions. This complexity, which is also
fuelled by the growing share of calls for projects and their low success rate over the period
under review, weighs directly on the work of infectious disease researchers. The latter devote
a reduced amount of time to research, which, combined with remuneration at a lower level
than the standards of comparable countries, reduces the attractiveness of French laboratories.
The crisis has illustrated these weaknesses, which the public authorities have endeavoured to
A rapid response to the health crisis
The reaction of French research in infectiology at the time of the health crisis was rapid.
Specific funding against Covid-19, through calls for projects and through other channels, was
put in place from the first weeks of emergence. Nearly half of infectious disease researchers
have reoriented their work on the new virus. Important publications have been produced, both
on fundamental aspects and on more applied research, making it possible to enlighten the
public authorities in the management of the crisis, for example on epidemiological modelling
or the effectiveness of such and such a molecule or therapeutic. However, as the Court has
already pointed out in its flash audit of July 2021 on the funding of public research in the fight
against the pandemic, the absence of strategic management has led to a dispersion of funding
and clinical trials, to the detriment of the most promising projects.
A transition between research and innovation hampered by the lack
of coordination of stakeholders and the lack of maturity of the
public-private ecosystem
The continuum between basic research, clinical research and innovation is still
insufficiently developed. The compartmentalization persists, in particular due to a separation
between the funding of the first by the ANR and the second by the clinical research hospital
programme (PHRC), and a lack of attractiveness of research for people with medical training.
The links between public research and industry can still be improved, in particular with
regard to the time limits for negotiating licences for the transfer of technologies.
Above all, the transition from research to therapeutic innovation encounters a difficulty
specific to the infectious diseases sector. Infectious diseases, concentrated in low-income
countries, suffer from a lack of interest on the part of industrialists, for lack of a profitable
economic model. The absence of a structure such as the American BARDA (Biomedical
Advanced Research and Development Authority) does not encourage private initiative and
explains, with the insufficiency of venture capital to finance the latest deployment phases of
therapeutic innovations, the small size of French biotechs in the sector on the eve of the health
While the scientific risk specific to the development of a new product should not be
overlooked, these structural weaknesses in the link between research and innovation in
infectiology as well as the lack of risk-taking have weighed on the possible development of a
vaccine. by a French stakeholder during the health crisis.
Breakthrough innovation research should, however, be subject to a framework at the
international level, conditioning its realization on a cost/benefit analysis and on adequate safety
conditions, starting with experiments which consist in increasing the virulence of a virus in the
laboratory, known as "gains of function". If the latter make it possible to improve scientific
knowledge, they constitute a non-negligible risk of the emergence of an infectious disease.
Avenues for making research on infectious diseases a national
The extension of ANRS's scope of competence in January 2021 to emerging infectious
diseases (ANRS-MIE) is a first response to the lack of coordination of funding and projects
during the first months of the health crisis. However, the scope, resources and role of this
agency still need to be clarified with a view to extending its competences, albeit gradually, to
all infectious diseases. This extension must go hand in hand with the granting, marking and
traceability of a permanent and constant financial allocation for the exercise of this extended
However, the sustainability of the resources made available to the Agency is not currently
guaranteed. For ANRS-MIE to be truly in a position to carry out its mission, the Agency could
also gradually be given a leading role in infectious disease research carried out by the various
research organisations abroad, in order to better coordinate French forces in low-income
countries and promote the so-called One Health approach. Based on a mapping of the forces
present, partnership and consultation work will have to be carried out in order to develop a
shared strategy.
A Health Innovation Agency has been announced as part of the 2030 health innovation
plan, which is part of an international movement to create breakthrough research funding
agencies. Its relationship with ANRS-MIE and the European structure HERA (Health
Emergency Preparedness and Response Authority) will have to be clarified, so as not to
multiply the decision-making centres, particularly in times of crisis.
Summary of recommendations
Ensure the long-term nature of public funding devoted to research on infectious diseases
Ensure priority and traceability of funds devoted to emerging infectious diseases
Gradually broaden the role of ANRS-MIE to the entire spectrum of infectious diseases, by
entrusting it with the funding of calls for projects in France and in the network abroad
Based on the mapping of French research forces in infectiology present abroad, define a
strategy and joint actions
Reform and strengthen support systems for research in infectiology, in particular by a
strong pooling of administrative services, so as to increase the effectiveness of research
in mixed units